SOHO 2025 | Exploring TKI de-escalation strategies in CML: outcomes of downgrading therapy
Elisabetta Abruzzese, MD, PhD, S. Eugenio University Hospital, Rome, Italy, comments on the strategy of de-escalating and downgrading TKI treatment in patients with chronic myeloid leukemia (CML), highlighting findings from a survey conducted among Italian centers. Of 170 patients, 33% who were de-escalated to a less potent TKI before downgrading showed an improvement in molecular biology, with 56% remaining stable. This interview took place at the 13th Annual Meeting of the Society of Hematologic Oncology (SOHO 2025) in Houston, TX.
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Transcript
This is a kind of new concept because usually we think about giving a higher potency TKI when you need to change therapy. You never downgrade the treatment, but now that time has passed by and we saw that there are many patients that won’t enter TFR and they experience long-term toxicities. We thought about that and we actually ran a survey last year among the Italian centers to see if someone was adopting this kind of strategy and we found that it is pretty much common...
This is a kind of new concept because usually we think about giving a higher potency TKI when you need to change therapy. You never downgrade the treatment, but now that time has passed by and we saw that there are many patients that won’t enter TFR and they experience long-term toxicities. We thought about that and we actually ran a survey last year among the Italian centers to see if someone was adopting this kind of strategy and we found that it is pretty much common. We enrolled 170 patients and we studied the kind of downgrading and we studied the possibility to enter TFR if people were de-escalated before downgrading and the outcome using a less powerful TKI. And surprisingly, 33% of these patients actually improved their molecular biology, 56% remained stable and only a small percentage lost the response and they recovered as soon as they changed treatment or increased the dosage of the drug.
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